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RESEARCH PRODUCT

Arthritis Associated with Ulcerative Colitis: Our Experience in Palermo

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To The Editor: Ulcerative colitis (UC) is one of the inflammatory bowel diseases, which affects the small intestine and colon [1]. The pathophysiology of UC is not known [2, 3]. The association between arthritis and UC is well known. The authors report the frequency of arthritis in 53 Sicilian patients with UC. The diagnosis of UC was made according to criteria described by Schachter and Kirsner [4]. The involvement of sacroilitic joints was assessed radiologically according to Bennett and Burch grade (0=normal joint, 1=suspicious sacroiliitis 2=abnormal joint with sclerosis and/or erosions, 3=unequivocally abnormal with erosions, sclerosis, widening or narrowing or partly ankylosed, 4=total ankylosis) [5]. All patients were screened for the presence of the antigen HLA B27. Arthritis occurred in 11 patients (20.7%). Patients with arthritis had high erythrocyte sedimentation rate (>20) and high C-reactive protein (mean value 14mg/L) at presentation. Latex fixation test rheumatoid factor (RF) was negative in all except one patient who had monoarticular knee involvement (RF = 45 IU/ml). Peripheral arthritis was found in 9 patients (17%). Only three patients had polyarticular involvement. The joints involved in peripheral arthritis were most frequently the knee joint (4 patients), followed by the ankle (3 patients), elbow (2 patients), wrist (2 patients), proximal interphalangeal (2 patients), shoulder (1 patient), and the hip (1 patient). Spondylitis was diagnosed in 2 patients (3.8%), one with sacroilitis grade 2 and the other with grade 3. Both patients with sacroilitiis showed positive HLA B27. In conclusion, our observation of the association between UC and arthritis is in line with previous reports in the literature [6, 7]. The basis of this association is unknown. A better understanding of the role of genetics and environmental factors may improve the treatments and prevention of the disease.